Occlusion
by julia-sets
Summary: Sam has a heart attack.


I wrote this last spring for the Hurt/Comfort Birthday event at the OhSam LJ community.

This fic tentatively starts sometime after episode 13x18 ("Bring 'em Back Alive") and continues through a couple episodes after that. It was posted before 13x20 but assuming it happens in between moments of episodes I don't think it's too AU.

I'd like to thank Interstitial for going above and beyond with help on the medical details. Any inaccuracies are definitely mine.

Happy 35th Birthday, Sam Winchester. Sorry we celebrate it by beating you up.

* * *

 _It's healthy. I'm watching my cholesterol, like you should be._

 _Yeah, I'm watching my cholesterol. Watching it go up._

 _-13x17, "The Thing"_

* * *

Sam starts gasping after the first mile. He normally only runs three or four and they're easy. No hills out here in the Kansas plains, just miles of country road so rural they don't even have shoulders. He was keeping a pretty casual pace and he's not recovering from any major injuries or illnesses so this first mile should've been a warm-up.

He stops. He's panting and dripping with sweat, plastering his hair to his forehead, his cheeks.

He doesn't often have the luxury of listening to his body. Usually he's in the middle of a fight and there's no choice but to push through the pain. There have been long stretches where his senses weren't reliable. He's good at ignoring himself.

But he's also trying to break some bad habits.

He turns around, heads back towards the bunker at a slow jog. A quarter mile in and he has to slow the pace to a walk.

He runs to music some days, podcasts on others. It means he carries his phone with him. He digs it out of his pocket. He's a little dizzy. It's manageable as long as he walks, but he usually hits this point closer to a marathon than a 5k.

He selects Dean's name from his contacts. He braces himself for his brother's teasing.

"What's up?"

"Dean?" Sam says. His voice is weaker than he expected. He really feels mostly okay.

"Sam? You okay?" Dean sounds concerned, not mocking at all.

"Yeah, yeah," Sam reassures. Because he is, he's okay. "Just… weird."

"Where are you?"

Sam glances around. The roads around the bunker are flat, straight Kansas highways. Uninterrupted cornfields.

Calculating distance on these runs is easy enough, because the intersections are spaced a mile apart. Rural Kansas like a patchwork quilt made of cornfields, stitched together by country roads. Square miles, literally. He'd only just passed an intersection when he'd turned around.

"Sam?"

Not many landmarks out here, but he's run this route many times. He recognizes one of the scrubby trees. Maybe. "I think about a half… mile out."

"You haven't been gone that long. How far did you run?"

"Mile."

Dean's quiet enough that Sam can hear the rustling on the other end of the phone. Doors opening, squeaking hinges. "Which direction?"

"East."

There's a rumble through the phone that Sam would recognize anywhere. Dean's driving.

"You don't… need to…"

"Can it, Sasquatch, you sound like hammered crap."

Sam wants to ask what that's even supposed to mean, but it doesn't seem worth wasting the breath.

A wave of dizziness hits and he stumbles, but manages to stay on his feet. "Shit," he mutters, forgetting that he's still on the phone.

"What happened?"

"Tripped."

"Sit down, Sam."

"'m fine." A half mile isn't that far in a car and Sam can already hear the familiar growl in the distance. "Hear you."

He squints west. The sun is setting, but he can make out the square black shape of the Impala thanks to the lack of hills.

He stops walking. Sweat drips in his eyes, so he shuts them. Dizziness hits hard and he sways, catches himself.

The rumble is closer. He'll just wait here.

"Sam?"

Sam opens his eyes. His brother is walking up, the car idling in the grass off the road behind him. Sam stumbles back, startled, but Dean grabs hold of his biceps to steady him.

"You can probably put your phone away," Dean says. His eyes search Sam's face, his body, looking for injury. But Sam's fine.

Sam looks at his hand, which is still holding his phone to his face. The screen is dark, when he brings it down the call has ended. He tries to put it in his pocket, misses, tries again, succeeds.

"Okay, let's get you into the car."

There's pressure on his arms, pulling. He steps forward. The hands guide him. He stares at his feet, watching them through the encroaching dark.

The hands push him down and he grabs at them in a panic, but he doesn't fall far. He's sitting. He blinks against the darkness. He's in the Impala. Dean is crouching outside the car. He's got one of Sam's wrists in his hand, fingers on the pulse point. He's frowning.

"Sam? You with me?"

"Yeah," Sam says.

"You think you can pull your feet in? We're gonna go for a drive."

"Where?" Sam asks, but he does as Dean suggests and turns in the seat, lifts his legs carefully into the footwell. Dean closes the door on him before rounding the front of the car, climbing in, putting it into gear.

"Not headed back," Sam points out.

"We're going to get you checked out."

"Not hurt."

"You can't even finish a sentence, Sam. You're not gonna win this argument."

Sam wants to argue more, but it's too exhausting. He leans his head on the passenger window. The glass is cool against his skin. He's still sweating. He feels a little carsick. He's tired.

* * *

Dean doesn't realize when Sam passes out, only knows that when he looks over at his brother a couple minutes later his eyes are shut and he doesn't respond when Dean calls his name. The road to the county hospital is a straight shot and Dean's already pushing 80 in a 65, but he bumps it up another fifteen. The sun's in his eyes but there are only a few cars on the road and passes by them so fast they look like they're standing still.

He turns off the main highway early, takes back country roads instead of going through town so he doesn't have to slow down.

It's twenty minutes to the hospital on a good day.

Dean makes it in closer to ten.

He pulls up to the ER and jumps out, shouting for help. The hospital is tiny, only one squat floor, barely a real ER. He pulls open the passenger side door and Sam slumps into his arms. He's regained consciousness, seems a lot more with it, but has a fist pressed to his chest almost unconsciously. Dean hauls him out of the car, tucks himself under one of Sam's arms and helps him walk shakily through the sliding glass doors.

"Little help?" Dean says, staggering under Sam's weight as his brother slumps a little more. There's a flurry of activity before a gurney appears before them. Dean helps them haul Sam up on it as they fire questions at him.

"What's his name?"

"Sam."

"Sam, can you hear me?"

Sam nods.

"Sam, can you tell me what's wrong?"

"Dizzy," Sam says between breaths. "Nauseous."

"Any chest pain?"

Sam frowns as though the question surprises him before nodding.

"He's got a pretty high pain threshold," Dean supplies.

"Okay, let's take him back."

The ER is small, only really room for one patient at a time, but they jump to the front of the line, ahead of the couple people waiting in the hard plastic chairs. Dean spares them a glance as he follows the gurney. He expects to see ire and annoyance that he's skipping, instead finds nothing but pity.

By the time he gets back there they already have an oxygen mask over Sam's face and they're slipping the pulse oximeter on his finger.

"I'm his brother," Dean explains. "He was on a run." Stupid, he thinks a moment later. Sam's wearing running clothes. His fancy Bluetooth headphones are dangling from his neck. Way to state the obvious.

"How old is Sam?"

"Thirty-four."

"Any history of heart disease?"

"No."

"He a smoker? Family history of heart disease?"

"No, he doesn't smoke. Uh, no family history, but, I don't know. Our parents died young. But Sam's healthy."

"Did he fall at all? Hit his head?"

"No, I don't think so." He answers the questions on auto-pilot as he watches them help Sam out of his running shirt, then attach sensors to his bare chest. Another nurse slides a blood pressure cuff up his arm.

"Sam? Did you fall or hit your head?"

Sam shakes his head as he watches them stick a needle into his arm.

"Let's start the ACS protocol," the doctor says, the nurses moving to comply even before her sentence is finished. They're giving him some pills to take by mouth, replacing the oxygen mask after they let him wash them down. Something's injected into his IV.

"Pulse rate 107, blood pressure is 156 over 98."

Dean has enough medical education to recognize that that's high, but not dangerous.

Another nurse is waiting as the EKG spits out a length of paper. "Clear ST elevation in leads 1, 3, and AVF."

Dean catches some surprise flit across the doctor's face before it smooths out into professionalism.

Surprise or no, her voices is calm. "Okay, let's call receiving in Wichita and Life Star, have them send the medevac. In the meantime let's get some blood work. I want a CBC, PT/PTT, electrolyte panel, cardiac enzymes."

"What's happening?" Dean asks as one of the nurses attaches a tube to Sam's IV and bright red blood spurts to fill it.

The doctor draws him to the side, breaks his line of sight. "Sam's electrocardiogram showed some ST-elevation."

"What's that mean?"

"We think he had an ST-elevation myocardial infarction. It's a type of heart attack. It's unusual in someone his age, especially without any family history, but not impossible."

The words don't register, something in Dean's brain snagging between hearing and understanding. "He had a what?"

"A heart attack."

"That's impossible. He's thirty-four. He doesn't… he eats kale for fuck's sake. How the hell did he have a heart attack?"

"It could just be genetics. Given that he's young and you said healthy, it could be a clot that developed somewhere else in the body. We've given him some medication to break the clot up, but they'll probably need to place a stent in as soon as possible. We're not set up for that here so we're going to be sending him to a hospital in Wichita."

"Is that surgery?" Sam's no stranger to surgery, but it's always been for injuries. Stabs and gun shots and slashes. Nothing like this. Nothing so serious.

Nothing so mundane.

"Not like you're imagining, not open-heart. They'll put a line in through his femoral artery, up to his heart, to try and figure out where the blockage is and put the stent in. It's minimally invasive."

Dean tries to imagine how anything going into his brother's heart could be considered 'minimally invasive'. "Can I come along in the ambulance?" Dean asks, already regretting that he'll have to leave the Impala here in the middle of nowhere.

"Actually, time is critical in situations like these, so we're requesting that they send a helicopter. You should be able to ride along."

For a second Dean thinks he's having his own heart attack.

Fuck.

The doctor must see something on his face, because she immediately gives reassurances. "Of course, you don't need to."

His fear of flying wasn't something he had to deal with too often. The last time they flew, when they visited Scotland to threaten Crowley's bones, Sam had procured some heavy duty sedatives and Dean slept through both flights.

"No, no, I'm going," Dean says. Wichita is a three hour drive. He has no idea what the travel time would be for the helicopter, but Sam had a heart attack. Dean needs to be with him.

One of the nurses reminds Dean that he needs to move his car and tells him which lot will be fine if he needs to leave it for a couple of days. He apologizes to Baby, running a hand across her dash, sends her a quick thanks for helping him to get Sam to the hospital. He locks her up and reenters the hospital.

He's only just stepped through the doors when he hears the steady beat of rotary blades. He picks up the pace and just makes it to Sam's bedside as they wheel him away. Sam's strapped to the gurney, conscious but a little out of it. Dean wonders if they've given him something for the pain. Sam gets loopy on pain meds. The oxygen mask has been replaced by a nasal cannula.

There's no dedicated helipad at a hospital like this, so the helicopter lands in an empty space in the parking lot.

Dean clenches a fist at his side as he approaches, the other gripping Sam's gurney. They get Sam set up to a bunch of new monitors inside as Dean fixes a set of heavy duty headphones over his ears and then, with a jerk, they're lifting off.

It's loud, even through the headphones. Dean can see that the people crowded around his brother are talking, but they must be on a different frequency from him. Dean hums under his breath, grateful that the ambient roar is enough to drown it out.

"You okay?"

Sam's voice is tinny through the headset. Dean can't help the incredulous look that he gives his little brother. Sam's with it enough to counter with a glare. "You hate flying." He's speaking easier, but still keeping his sentences short.

"I'm fine," Dean grouses.

Sam reaches a hand out, grabs hold of Dean's. Dean rolls his eyes. Morphine never fails to make Sam clingy.

The copter shudders as it hits an air pocket and Dean reflexively tightens his grip.

"Shut up," he says in response to Sam's loopy grin.

* * *

Dean's filling out the paperwork. When they get hurt on hunts they usually just use fake IDs and leave behind a mound of medical debt. Hospitals can't turn away a patient bleeding from a gunshot or stab wound. He and Sam have been legally dead for a few years now anyway, so it's not as if they need to worry about messing up their credit scores. And they don't usually end up at the same hospital twice.

But they can't really afford to burn any bridges so close to the bunker. Even if Sam's now under the knife in Wichita, there is a paper trail connecting him back to Smith County Memorial.

He knows that Sam has done this stuff before, has created fake insurance cards. But that's Sam's thing, especially when it came to making something legitimate enough to not get the cops called on them. Dean generally leaves it up to him.

For now he ignores that, telling the nurse at the desk that he left his insurance card back at home and, no, he can't remember which provider because he thinks they just switched. It'll have to do for now. Until he can ask Sam about it.

There's no other alternative.

The rest of the other information is easy. They have a PO Box in Red Cloud, Nebraska, just north of the state line, he puts that on the address line. He supplies the name Sam Vaughn, their most recent 'legitimate' identification, created by Sam to stand up to scrutiny by shady relic dealers. They'd been caught out, but not because of the paperwork, so Dean's hoping it'll hold up.

Sam doesn't have any allergies. No current medications.

Past medical history.

Dean taps the pen on the clipboard.

None of the checkboxes apply—no asthma, he doesn't even know what atrial fibrillation means, so probably not. He reaches "last menstrual period" and can't even make a joke. He hesitates at "seizures/epilepsy". Do seizures caused by memories from hell count? In the end he skips it.

He flips to the next form on the clipboard.

 _Advance Directive for Resuscitation_

He can't do this.

Dean winds his way through the hallways until he finds an exit. It opens out into a small interior courtyard with a couple of metal picnic tables. The sun's set and the whole thing is lit by the orange of street lights and light pollution and the harsh white light from patient rooms. Dean digs out his cell phone.

"Dean?" is how Cas answers on the second ring.

"Cas," Dean says. "Where are you?"

"Currently I am in Louisiana." There's a swell of muffled shouting in the background.

"Well, you need… wait, where in Louisiana?"

"The French Quarter."

"You're in New Orleans?" Dean says incredulously. Cas had left to try and find any traces of Gabriel.

"Sam suggested I look here. He assured me that it's the type of place Gabriel would frequent."

Dean can't argue with his brother's logic. He shakes his head and discards the first few responses. "Listen, man, you gotta get back here."

"Is something wrong? Are you injured?"

"No, not me. It's Sam." Dean takes a deep breath and it shakes on the inhale. "He had a heart attack. We're at a hospital in Wichita. They're doing some procedure, I didn't really understand what it is, but they're messing around with his heart, Cas."

"I can head back immediately. It'll take some time."

Dean pulls up his mental map of the United States. "If you head north to Shreveport and hop on I-20 west you can skirt Dallas and take I-35 all the way up here." Dean prefers county highways, but he knows every interstate in the lower forty-eight. "Probably twelve, thirteen hours?" He's usually pretty happy that angels can't pop in on him by surprise anymore, but right now he misses Castiel's wings.

"I'm heading out. You will be okay until then?"

"Yeah, man, yeah."

Cas, still not one for long good-byes, hangs up.

Dean glances down at the clipboard he's still holding.

* * *

The doctor is looking for him when Dean heads back inside.

"Your brother is in recovery."

"Already?" Dean asks in surprise.

The doctor smiles. "The procedure went very well. It's minimally invasive, we didn't even have to put Sam under. He might be a little groggy, but he should clear the drugs soon. You can go sit with him if you want."

She takes the clipboard that Dean hands her.

Sam's sitting up in the hospital bed. He's conscious and probably seems fine to the hospital staff, but Dean knows his kid better than anyone else on Earth. Something's wrong.

"Sammy? You okay?"

Sam stares at him intently. His face is a shade too blank, his eyes too searching.

Dean steps closer, slowly. He takes his hands out of his pockets, keeps them open at his side so Sam can see that they're empty.

"Sam?" Dean tries again. "You wanna say something?"

"This isn't real," Sam says and Dean feels his stomach clench. Fuck.

"Oh yeah?" Dean replies, keeping his tone light. They haven't had an issue like this in years. "What makes you think that?"

"I was just…" Sam starts, before glancing around. He's pressing on his hand, on the long healed scar. Dean's seen him do it before, like a nervous tic. He's always hoped that was all it was, but now he's starting to worry that it's more serious than that.

"Just what?" Dean prompts.

"I was there," Sam says. "Back there."

He means in the Cage. If Dean wasn't so focused on remaining nonthreatening he'd be swearing.

"You're in Wichita," Dean says. "A hospital in Wichita. You had a heart attack. Do you remember?"

Sam's face scrunches up as he thinks. Yeah, kid is definitely still flying high. "I was running," Sam says slowly.

"Yeah, you called me. They flew you down here."

That seems to trigger something. "You were freaking out," Sam says with a hint of teasing, his posture relaxing infinitesimally.

"Shut up," Dean shoots back.

Sam frowns. "But then… I was… That was all before. Before I went back there."

Dean shakes his head. "They did some procedure, had you sedated. I swear, Sam, I swear you weren't back there. You were here the whole time. It wasn't even that long, not even an hour."

Sam nods like he's taking this information in. Dean can see him struggling, probably with whatever they've doped him up with.

"It doesn't feel real," Sam says.

Dean breathes out a sigh. "Yeah, well, they've got you on plenty of morphine. So that that's probably normal, kiddo."

"Yeah?"

"Yeah, definitely. You got all clingy on the helicopter ride over."

Sam grins. "That's not how I remember it."

"Shut up."

"Listen, I'll tell them to get you off the hard drugs, okay? Will that help?" Something like relief breaks over Sam's face and cracks Dean's heart into pieces. His little brother is relieved to not be on pain medication because it makes him doubt reality. Their lives are so fucked. Dean blinks a couple times, hard. "Here, let me go tell a nurse."

He's a coward.

He finds a nurse at the desk on the floor working on some sort of paperwork. "Hey, can you guys take my brother off the morphine or whatever?"

She looks up from her work. "Is he okay?"

He nods, thinks twice about it.

She must see something in his expression. "There are some rare side effects of the drugs they had him on. Mood changes, flashbacks, that sort of thing."

"Flashbacks?" Goddamn it.

The nurse nods, her face softening. "They're rare, but they've had some problems in people with PTSD. But they only used those drugs during the procedure, so he should be coming off them pretty quickly. But if it helps we can reduce his morphine." She gets up and Dean follows her back to Sam's room.

Sam looks a bit more with it this time, but still wary. The nurse is kind as she fiddles with one of the machines next to Sam's bed. "Your brother says you want to be a tough guy."

Sam gives her a shy smile that would probably have her asking for his number if she wasn't old enough to be his mom. Maybe even then.

"You might still have some numbness in your leg," she continues. "They used some local anesthetic where they made the incision."

"My leg?"

"Yeah, they use the vessel in the leg to access the heart."

"Was I unconscious?"

"I wasn't in the procedure room, but it's usually conscious sedation. But people often don't remember the procedure, it's a side effect of the drug, impairs short term memory."

"Like you got roofied," Dean jokes.

Sam shoots him a glare and, shit, yeah, that was an asshole thing to say. The professional but disdainful look from the nurse confirms it. Dean ducks his head, tries to center himself. Sam's good, Sam's going to be fine.

The nurse turns back to Sam. "You should be feeling more yourself soon." She gives him a pat on the shoulder before leaving the room.

"You feeling any better?" Dean asks.

Sam is quiet. He's looking at his hands, rubbing a thumb across the scar on his palm, but not pressing down. "Yeah. Great."

* * *

Sam spends three days in the hospital. He manages to give Dean the information for their illicit health insurance, even shows it to Dean where it's saved on his phone in case something like this happens again. Cas shows up around noon the first day after the heart attack. He lays a hand on Sam's chest and there's a rush of cool energy. Cas tells Sam that he was able to heal a small amount of the damaged tissue, but couldn't fix everything. Sam offers reassurances even as Dean looks put out by the angel's inability to help more.

In any case, the doctors are impressed at Sam's recovery. If this is a quick recovery then Sam can't help be grateful for any help Cas gave him, because Sam feels like _shit._

Before this he was running several miles most days. Now he gets winded walking around the hospital floor.

Overall, though, Sam's prognosis is good, as the doctors reassure him. As the doctor back in Smith Center guessed, the heart attack had nothing to do with clogged arteries. It was a freak accident. Sam tries to find it in himself to be reassured by that, but he can't help but rail against the colossal, cosmic unfairness of his life. He should be used to it by now.

By the third day Sam is able to stay awake for most of the day and they release him with a long list of recommendations for rehabilitation and physical therapy.

Cas drives them back to Smith Center. The drive takes a full three hours and by the end Sam is grimacing with discomfort and trying to be sneaky about rubbing his chest. Dean tries to insist that they drop Sam off at the bunker first, but Sam mentions that they'd be leaving him alone and that's enough leverage to get Dean to cave.

Sam insists on switching cars when they get back to Smith Center Memorial. He wouldn't admit it under pain of torture, but he missed the car. Even more, he appreciates the way some of the tension bleeds out of Dean's shoulders the moment he's behind the wheel. Dean's been painfully upbeat ever since the first night in the hospital, but Sam can see through the act. He doesn't call his brother on it because he knows that Dean needs it, needs to feel helpful. It's an easy enough thing to give.

When they arrive Sam has to take the steps down from the garage one at a time. It's humiliating and Dean's concerned hovering just makes it worse. Neither of them have ever been good at dealing with weakness.

Dean gets Sam into his bed and as comfortable as he can make it before disappearing into the kitchen. Sam thought about mentioning that he wasn't hungry, but at least it stopped the hovering. Cas didn't return to the bunker with them, instead opting to continue his search for Gabriel after getting plenty of reassurances from Sam that he'd be fine in the angel's absence.

Dean reappears a half hour later and wakes Sam out of his doze with a plate of food. Sam's surprised to see it resembles the rabbit food that Dean often teases Sam about. Except his brother is actually pretty handy in the kitchen and this food doesn't look up to his normal standards. A plain chicken breast over white rice, with a couple small boiled potatoes and a banana rocking next to the plate on the tray. It's very… white. Very plain.

Sam glances up and Dean grimaces. "You heard the doctors, gotta avoid salt for a while. I'll run out tomorrow and get some better vegetables, but this is the best we've got for now."

Sam stabs at a potato as Dean takes a seat in his desk chair. "Are you seriously going to just watch me eat? What about you?"

"I already ate mine," Dean says dismissively. At Sam's look he ducks his head. "The marinade I used for the chicken had too much salt in it. Sorry."

Sam smiles. Dean feels guilty for eating good food. It's so ridiculous, so out of their normal range of behavior, that he can't help but find it funny.

"So, uh, I was thinking you might want a shower after this. I'm sure the sponge baths were great, but you've looked better."

Dean knows perfectly well that Sam had several showers at the hospital, all with some level of help from the very professional nurses. He's so caught up in his brother being an asshole that he misses the implication at first. When it hits him he almost chokes on a piece of chicken.

"Dude, you are not helping me shower."

Dean pulls a face. "It's not like I'm looking forward to it. But it's better than having to help your ass up when you fall over and hit your head or something."

"No. Fuck off."

"It's nothing I haven't seen before, you baby."

"I will stab you with this fork."

Dean laughs and Sam can't help but follow. The past few days have sucked. They've had worse—they've had a lot worse—but the mundanity of this particular situation has thrown them both off kilter. Hexes and gunshot wounds, sure. A heart attack? That's something neither of them was ever prepared for.

Dean eventually does let Sam shower by himself, though he shadows him down the hall and insists on standing outside the room in case Sam runs into any difficulty. There's also a small metal stool in the shower that wasn't there before. Sam scoffs, but halfway through he has to use the damn thing for a couple minutes. Not that he'd ever tell Dean. At least the water pressure is nice.

Sam makes the walk back to his room with Dean gripping his elbow. He's aware that he probably looks a little pale, but at least he feels much cleaner.

It's still early in the day, but Dean doesn't say anything when Sam says he's going to go to sleep. Sam finds himself a little put out that his brother doesn't even attempt to tease him for being boring or old or something, but of course that's ridiculous.

Sam settles into his bed and tries to remind himself that tomorrow will be better.

* * *

The next day is better, actually. And the day after that. It takes a few days, but eventually he doesn't get tired walking down the hallways. He looks up rehabilitation for after heart attacks and does some basic exercises in the safety of his own room. He keeps the door closed. He's not sure which would be worse: Dean making fun of how pathetic he is now or Dean doing nothing of the sort.

They can't afford to completely take time off, not with Mom and Jack still stuck in another universe. The second day after Sam gets home he insists that Dean bring him books for research. A week after the heart attack Sam is already well enough to prowl through the archive himself, at least for a short while. Dean's let up on the mother-henning and mostly leaves him to his business, though with frequent checkups.

They sent Sam home with a heart monitor. It hooks up to his chest, wires trailing from under his shirt to the actual machine. The machine comes with a black bag, just smaller than a laptop case, which has a long fabric strap for convenience. Sam has to carry it around with him everywhere.

Dean calls it a purse.

Sam glares a him.

It does look like a purse.

Sam gets him back, though. While he's sorting through the archives he stretches up to grab a book and one of the sensors gets dislodged. The monitor, of course, loses the signal of his heartbeat and it starts blaring out an alarm.

Loudly.

Sam startles and fumbles with the machine, trying to figure out how to shut the alarm off. Like any good alarm, the sound is just distressing enough that it's hindering his ability to think straight and find the correct buttons. Annoying.

"Sam?!"

Dean enters the archive at a run, wide-eyed and still carrying a butter knife from, Sam assumes, where he was preparing food in the kitchen. He doesn't even seem to realize that he's holding it.

He takes in the sight of Sam standing, seemingly healthily, and glances down at the monitor. "What the hell?"

"One of the sensors came off," Sam explains, nearly shouting to be heard over the alarm. He finally finds the button and the siren cuts off mid-beep. Finally.

Dean lets out a drawn out breath, clearly still dealing with an adrenaline high. "Holy fuck, man."

"Yeah, sorry."

Dean's mouth thins, twists. He doesn't move from the doorway.

"I'm fine, it was a false alarm. I've just got to get this thing reattached," Sam says, fumbling with the sensor. His hands are shaking a bit. Dean's not the only one coming down off an adrenaline high.

"Gimme that," Dean says, moving forward. He sets the butter knife down on the shelf and grabs the lead. Sam holds his undershirt up as Dean carefully replaces the sensor, callused fingers smoothing down the tape and pressing it to his skin. Sam drops the shirt and checks the monitor, which is reading all green again.

"C'mon, it's lunch time."

Sam makes a face. "I'm not really that hungry." He can imagine the food that's awaiting. He thought that he'd be in good shape with the necessary diet, since he already ate pretty healthily. But he had no idea how important salt was. He misses flavor.

"Uh-uh, nope. You just took about eight years of my life with that stunt. You're taking a break and eating something if I have to drag you to the kitchen."

Dean does look a little pale under all the irritated bluster.

"Fine , but I'm bringing a book," Sam says, faintly echoing the years before Stanford, when he'd do his homework at the motel table.

Dean rolls his eyes. "Sure thing, geek. Let's go."

* * *

When Sam sees the article about the executive spontaneously combusting in Oregon he hesitates for only a moment. This is a real hunt. They haven't had one since Sam's heart attack. It's been a couple weeks. Sam's probably doing better than anyone could possibly expect, but he still isn't sure about testing his abilities this quickly.

But giving Rowena the page from the Black Grimoire, allowing her to regain her powers, that's on Sam.

He does pretty well, overall. He gets a little freaked out when he finds out that a reaper has been stalking them. Wonders if she was there on that lonely Kansas highway, there in the hospital when the doctors were threading a cable through his veins.

Sam's winded by the time he manages to confront Rowena outside the hotel. His vision is going a little wonky, but his hand is steady on the gun.

He doesn't want to shoot her. He trusted her.

But Dean is right.

He takes the shot.

And can't help the part of him that's relieved when she stops the bullet.

After he wakes up from her sleep spell he tries to reason with her. He begs. When she approaches him, some unknown spell component cupped in her hand, he can't help but freak out.

And then when she drives her palm into his chest it's just like the heart attack all over again, but worse. Much worse.

After it's all over, after Billie and after Rowena agrees to help them out, Sam can't help but rub at the lingering ache in his chest. It's an unconscious movement, but Dean zeroes in on it like a laser.

"Sammy? You okay?"

Sam nods, but he keeps rubbing at his chest. He can't help it. It's only a little sore, but he's a bit gun shy about chest pain at the moment.

Rowena is watching them with clever eyes. They generally try to avoid letting the enemy in on their weaknesses, but Rowena is in a strange place right now. She's not really an enemy. Sam wouldn't call her a friend, either. He's going to have to kill her someday, after all.

Sam's fine. He's going to have to be.

* * *

It's almost a month after the heart attack when Dean stops by the PO Box up in Red Cloud and finds the bill.

Sam's bullshit fake insurance managed to cover his hospital stay, but apparently even that has limits. And the limit is on a helicopter flight.

$8,349.74.

Holy shit.

Dean throws the bill along with the rest of the mail (a couple new fake credit cards, junk mail, a package from Amazon) onto the passenger seat and heads back to the bunker.

"Sam, you got a package," Dean calls out when he enters the main part of the bunker from the garage.

Sam's seated at the table, poring over some books. "Awesome."

"Yeah? What is it?

"Spell ingredients," Sam says absently, still wrapped up in his research.

"Huh," Dean says, shakes the small package next to his head. Nothing rattles around. "So what is it? Bone of a lesser saint? Eye of newt?"

Sam finally glares at him, but it's mild. "They're herbs and you're lucky they're not fragile. Jerk."

Dean laughs and sets the package next to Sam.

"What's that?"

Dean looks down at the envelope in his hands. He thinks about hiding it, had considered it on the way back to the bunker. Sam really doesn't need to worry about money problems. Given the choice, Dean wouldn't have done anything differently.

But Sam had a point about Dean trying to protect him from things that he didn't need protecting from. Dean's not ready to see his brother get hurt. He doesn't think he could let Sam jump as he had in Stull, not again. He isn't that strong anymore. If there's anything he can do to keep Sam safe, he'll do that. But maybe, despite all his long ingrained instincts, Dean doesn't need to protect him from everything.

He hands over the bill, watches as Sam realizes what it is.

"Wow."

"I know, right? Shouldn't our magic insurance cover that?"

Sam shrugs. "Transportation isn't always. People in cities have been using more ride-sharing services like Uber to go to hospitals, to try and save money." He looks up in time to catch the incredulous look that Dean is favoring him with. "It was on NPR."

"Okay, nerd. Either way, we probably want to pay that one. Just in case we ever run into trouble here again. Don't want them turning us away."

"Well, I don't think that's technically legal," Sam starts, before catching Dean's look. "But we should be able to cover this."

Now that one's a surprise. "Wait, what? You have eight thousand dollars just lying around?"

Sam gives him a look that's studiously blank and it makes the anger rise in Dean. He was trying to be honest and here Sam is, keeping secrets.

Sam pushes away from the table, gives Dean his full attention. "I've been saving some money. We run through a lot less of it now that we mostly stay at the bunker. I'm sorry I didn't tell you."

The worst part is that Dean can't even really be mad. It's not like Sam hasn't been pulling his weight financially. Sam does more than his fair share, hustles pool at almost the same pace and does the brunt of the work getting them fake credit cards. Sure, they stay in shitty motels, but nothing's really changed on that front. They're not going without or anything. If Sam's saving money, it's money he's earned. Though Dean does have to wonder where he's storing it. Whether there's an account somewhere or if it's just wads of cash stuffed in his mattress.

"You saving up for retirement or something?" Dean tries to joke.

Sam tilts his head and gives him a look that freezes Dean where he stands. Because, apparently, that's exactly what Sam's doing. And that's too big for Dean to consider. To imagine that Sam sees them growing old. Dean's always known where his story ends. He's said it enough times, including to Sam. Dean's going to go down swinging.

And it's not as if Sam hasn't believed the same, at times. It wasn't that long ago that Sam was telling him that they'd end bloody. End bad.

To think that Sam is saving up for something after? To think of an after? It knocks his world slightly off axis.

Because Sam's not wrong, they're getting old. Sam just turned 35. Dean's pushing 40 and his knees crackle like Rice Krispies when he goes up and down stairs. He's not really hung up on the year because, you know, it's better than the alternative. Dean never imagined making it this far. And, honestly, he hasn't made it this far. He's died. But against all odds right now he and Sam are here and alive and even though they keep running up against bigger and badder enemies, they also keep making it through. True, at any moment their luck might run out. But it's starting to seem like there's an equal chance that they might just keep on keepin' on.

He can't handle the look that Sam is giving him, pleading and hopeful and tentative. It's just like Sam to have a heart attack and come out the other side optimistic about the future, convinced he'll reach old age. It's all so _Sam._

Dean opens his mouth for a quip. Nothing comes out. He says something, some dumb excuse that he forgets immediately after the words leave his mouth, and leaves Sam sitting there in the library. Leaves him with his damaged heart and his hope and his secret stash of who-knows-how-much money.

Dean knows Sam better than he knows anyone else in the whole universe, but the kid will never stop surprising him.

* * *

"You two ready to order some food?"

This place is about three steps up from their normal fare. Lots of exposed brick and Edison bulbs. Sam doesn't mention it and Dean acts like they normally eat at places with an international tap list.

"I'll have the pear and walnut salad," Sam says, after consulting the nutrition app on his phone. He's been off of food restrictions for a long time, but he's more cautious now than he used to be.

"And you?"

Dean looks up from the menu. "Burger, medium-rare."

"And for your side? Fries, chips?"

"Uh, side salad?" Dean says, studiously avoiding Sam's gaze.

"Sure thing." The waitress drifts away.

He can't avoid Sam forever. When he looks he catches the full force of Sam's grin, dimples and everything.

"Shut up and drink your beer."


End file.
